Mammogram Logjam Increases Fear Factor

The American Cancer Society recommends that women over 40 have an annual screening mammogram, but scheduling mammograms is increasingly difficult. Some imaging centers in highly populated areas like Los Angeles are unable to make appointments sooner than six to eight weeks ahead. This has been blamed on the increase in the number of women requiring mammograms, the higher cost of delivering the service and the relatively small amount that most health maintenance organizations will pay for them. Rita Luther talked to Dr. RITA PERELLA, director of 2121 Wilshire Outpatient Radiology Diagnostics in Santa Monica, about what this means to the health of women.

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There seems to be a fear-based anxiety on the part of women who are told they have to wait for a mammogram. But it isn’t harmful to wait a month or even two if it is a “screening” mammogram (a regularly scheduled test when there is no suspicion of a problem). If a woman or her doctor has detected a lump or if a woman has had a mammogram that shows a possible problem, a “diagnostic” mammogram would be given high priority. In this case it would be appropriate to insist on an appointment as soon as possible; most imaging centers make special accommodations to handle these situations.

One reason for the wait that some women encounter has its basis in recent changes in laws regulating imaging centers. In 1994, the Federal Drug Administration took over regulating imaging centers and imposed many strict new rules relating to equipment. Imaging centers are now required to have their equipment tested by a physicist who charges an annual fee, and certification of technicians is now required. Office personnel must be trained to use sophisticated new software to meet reporting laws.

While these rules have had a positive effect in offering better care for patients, the FDA did not make provisions for reimbursement to cover the additional costs. The price of delivering a mammogram has increased, while the majority of insurance companies’ reimbursement has not.

Many imaging centers are either breaking even or losing money and must supplement their income with other imaging services. Some centers have closed and others have combined resources to try to make ends meet. Many centers have tried to reverse the losses by following the guidelines for screening versus diagnostic mammograms set up by the regulatory agencies. It was argued that by not having their radiologists see screening patients, you could perform more mammograms each day, which would offset losses. As a result patients are shuffled in and out.

This has created a tremendous amount of dissatisfaction for me personally and for my patients. I no longer see “screening” patients and many have never met me--the person who is making critically important decisions about them.

One possible solution to the problem would be convincing insurance companies to absorb the extra costs created by the regulation requirements. That is not likely to happen any time soon. However, getting the message out to women that having to wait six to eight weeks for a screening mammogram is not harmful could relieve the distress that many women experience.